Can you make an anonymous report?

Please understand, that anonymous reports limit the university's ability to respond and sharing your identity may be helpful to connect you with resources, like medical and counseling services, and provide information about your options for further action.

What if I am a Responsible Employee reporting an incident I have learned about that involves another person?

If you are reporting as part of your requirement as a responsible employee under Title IX, you can identify your role in STEP 3 of using this form.

The information provided in this report can be used by the university to conduct an investigation or take actions to stop the behavior and prevent its recurrence. If you have other questions contact the Title IX coordinator by email or by phone 713-­743-­8835.

Step 1: Information on person submitting this form

First Name

Last Name

Title

Department

Status

Phone Number

Email

Nature of this report:

Incident date

Incident Location

Specific Location

Step 2: Involved Parties

Name

Gender

Role

Date of Birth

Phone

Email

Hall/Address:

Step 3: Questions

Who are you submitting this report about?

Is the reporting party/victim in this report any of the following?

Is the responding party/alleged in this report any of the following?

When did you become aware of this incident?

Are you reporting as a Responsible Employee?
yesnounsure

If yes,

What is your Peoplesoft ID

What is your Department Name

Description of Incident: Provide as much detail as you can regarding the date(s) and place(s) of alleged violation(s); the nature of alleged violation(s); detailed description of the specific conduct that is the basis of alleged violation(s).

Other Information: Please provide any other information you believe might be helpful. For example, text messages or other evidence, if have you filed a criminal complaint, other extenuating circumstances. You can attach copies of document pertaining to the alleged violation using the supporting documentation section below.

Action Requested: By completing and submitting this form I am requesting the following:

I am initiating a Report of a university policy violation and would like to be contacted with more information regarding my rights and responsibilities outlined in the UH Sexual Misconduct Policy section 7 before an investigation is started.

I am submitting this report as a responsible employee for Informational Purposes Only and would be willing to provide more information upon request.

I am submitting this report ANONYMOUSLY and DO NOT want to be contacted further about this matter.

I am still undecided regarding any action to request.

Have you filed a criminal report with the campus police?
yesno

Would you like to file a criminal report with campus police?
yesno

Are you in need of living, class, or work assistance relateding to this report? If so, please explain.

Step 4: Supporting Documentation/Attachements

Photos, video, email and other supporting documents may by attached below. Each file can not be larger than 15 mb.